Emergency First Aid - How to Perform CPR for Infants

CPR stands for cardiopulmonary resuscitation. It is a lifesaving procedure that is done when someone's breathing or heartbeat has stopped. This may happen after choking, suffocation, drowning, or other injuries. CPR involves:

• Rescue breathing, which provides oxygen to the lungs.
• Chest compressions, which keep the blood flowing.

If blood flow stops permanent brain damage or death can occur within minutes. Therefore, you must not stop these procedures until the heartbeat and breathing of the infant return, or trained medical help arrives.

This article discusses CPR performed on an infant.

Considerations

CPR can save life, but it is best done by someone has undergone CPR course or training. The procedures outlined here are not a substitute for CPR training.

Parents and those who take care of children must know infant and child CPR if they haven't already.

The newest techniques emphasize compression over rescue breathing and airway, reversing long-standing practice.

Causes

 There are many factors that make the breathing and heartbeat of infant to stop. Other reasons you may need to do CPR on an infant are the following:

• Choking
• Drowning
• Electrical shock
• Excessive bleeding
• Head trauma or serious injury
• Lung disease
• Poisoning
• Suffocation

Symptoms
Cardiopulmonary Resuscitation should be done if the infant has the following symptoms:

• No breathing
• No pulse
• Unconsciousness

First Aid 

The following CPR steps are based on instructions from the American Heart Association.

1. Check for alertness:
   
   
   • Shake or tap the infant gently. See if the infant moves or makes a noise. Shout, "Are you OK?"
2. If there is no response, shout for help. Tell someone to call 911 or your local emergency number. Do not leave the infant yourself to call 911 until you have done CPR for about 2 minutes.
3. Carefully place the infant on their back. If there is a chance the infant has a spinal injury, two people should move the infant to prevent the head and neck from twisting.
4. Perform chest compressions:
   
   • Place 2 fingers on the breastbone -- just below the nipples. Make sure not to press at the very end of the breastbone.
   • Keep your other hand on the infant's forehead, keeping the head tilted back.
   • Press down on the infant's chest so that it compresses about 1/3 to 1/2 the depth of the chest.
   • Give 30 chest compressions. Each time, let the chest rise completely. These compressions should be FAST and hard with no pausing. Count the 30 compressions quickly: "1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30, off."
5. Open the airway. Lift up the chin with one hand. At the same time, tilt the head by pushing down on the forehead with the other hand.
6. Look, listen, and feel for breathing. Place your ear close to the infant's mouth and nose. Watch for chest movement. Feel for breath on your cheek.
7. If the infant is not breathing:
   
   • Cover the infant's mouth and nose tightly with your mouth.
   • Or, cover just the nose. Hold the mouth shut.
   • Keep the chin lifted and head tilted.
   • Give 2 rescue breaths. Each breath should take about a second and make the chest rise.
8. Continue CPR (30 chest compressions followed by 2 breaths, then repeat) for about 2 minutes.
9. After about 2 minutes of CPR, if the infant still does not have normal breathing, coughing, or any movement, leave the infant if you are alone and call 911.
10. Repeat rescue breathing and chest compressions until the infant recovers or help arrives.

Keep re-checking for breathing until help arrives.

 DO NOT 

• Do NOT Lift the infant's chin while tilting the head back to move the tongue away from the windpipe. If you think the baby has a spinal injury, pull the jaw forward without moving the head or neck. Don't let the mouth close.
• If the infant has normal breathing, coughing, or movement, DO NOT begin chest compressions. Doing so may cause the heart to stop beating.

 When to Contact a Medical Professional

• If you have help, tell one person to call 911 while another person begins CPR.
• If you are alone, shout loudly for help and begin CPR. After doing CPR for about 2 minutes, if no help has arrived, call 911. You may carry the infant with you to the nearest phone (unless you suspect spinal injury).

Prevention 

Most children need CPR because of a preventable accident. The following tips may help prevent some accidents in children:

• Never underestimate what an infant can do. Assume the baby can move more than you think.
• Never leave an infant unattended on a bed, table, or other surface from which the infant could roll off.
• Always use safety straps on high chairs and strollers. Never leave an infant in a mesh playpen with one side down. Follow the guidelines for using infant car seats.
• Teach your baby the meaning of "Don't touch." The earliest safety lesson is "No!"
• Choose age-appropriate toys. Do not give infants toys that are heavy or fragile. Inspect toys for small or loose parts, sharp edges, points, loose batteries, and other hazards.
• Create a safe environment. Watch children carefully, particularly around water and near furniture.
• Keep toxic chemicals and cleaning solutions safely stored in childproof cabinets.
• To reduce the risk of choking accidents, make sure infants and small children cannot reach buttons, watch batteries, popcorn, coins, grapes, or nuts.
• Sit with an infant while he or she eats. Do not allow an infant to crawl around while eating or drinking from a bottle.
• Never tie pacifiers, jewelry, chains, bracelets, or anything else around an infant's neck or wrists.

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References:

• Hazinski MF, Samson R, Schexnayder S. 2010 Handbook of Emergency Cardiovascular Care for Healthcare Providers. American Heart Association. November 2010. 
• Medline Plus - http://www.nlm.nih.gov/medlineplus/ency/article/000011.htm
• You Tube - AHA Infant CPR - http://www.youtube.com/watch?v=OmqGJiH5InQ
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Update Date: 9/2/2011

Updated by: Jacob L. Heller, MD, Emergency Medicine, Virginia Mason Medical Center, Seattle, Washington, Clinic. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.